Postradiation Problems Cause Long-Term Pain

Nov 1, 1999

Volume:

8

Issue:

11

VIENNA, AustriaMost long-term breast cancer survivors who have
had adjuvant radiotherapy are likely to have significant pain or
functional impairment even 10 to 16 years after treatment, but fewer
than one third receive pain medication, Ulf E. Kongsgaard, MD, of the
Norwegian Radium Hospital, Oslo, said at the 9th World Congress on Pain.

From a series of 2,113 women who had been treated with adjuvant
radiotherapy to the breast wall and/or regional lymph nodes, the
researchers evaluated 354 of the 450 patients who survived until
1996. Median observation was 10 years for women who had been treated
with 2.5 Gy × 20 and 16 years for women who had been treated
with 4.3 Gy × 10.

Arm edema, fractures of the ribs, and impaired shoulder
function were the three most objective factors predicting late
radiation side effects, Dr. Kongs-gaard reported. Pain
interference in the patients life, evaluated by the Brief Pain
Inventory (BPI), was characteristic in most patients.

Patients who had received the 4.3 Gy dose had more severe late
effects than those treated with the 2.5 Gy dose. Median BPI pain
scores were 19 of a possible 40 after 4.3 Gy and 15 of a possible 40
after 2.5 Gy. Median BPI reduced function scores were 34 of a
possible 70 and 26 of a possible 70, respectively.

Despite a high sum on the BPI pain score, only 136 patients
(37%) were on pain medication, Dr. Kongsgaard said. These
included 61 patients (15%) on acetaminophen, 67 (14%) on
acetamino-phen plus codeine, and 25 (6%) on aspirin or NSAIDs. Four
patients were taking antidepressants, and none were on
anti-convulsants. Only 9 patients (2%) were taking strong opioids.

The investigators concluded, Late sequelae after breast
irradiation are associated with physical and psychological distress
compromising quality of life. These problems are possibly
underestimated.